Provider Demographics
NPI:1952916801
Name:HINOJOSA, ANDREA EVELYN (MS RDN CLC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:EVELYN
Last Name:HINOJOSA
Suffix:
Gender:F
Credentials:MS RDN CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2832 AUXPLAINES AVE
Mailing Address - Street 2:
Mailing Address - City:RIVER GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60171-1408
Mailing Address - Country:US
Mailing Address - Phone:708-705-1613
Mailing Address - Fax:
Practice Address - Street 1:2832 AUXPLAINES AVE
Practice Address - Street 2:
Practice Address - City:RIVER GROVE
Practice Address - State:IL
Practice Address - Zip Code:60171-1408
Practice Address - Country:US
Practice Address - Phone:708-705-1613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL86054710133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
320686OtherCERTIFIED LACTATION COUNSELOR